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Abstract
Background: Gonadotropin releasing hormone (GnRH) antagonists suppress follicle-stimulating hormone (FSH) to lower levels than GnRH agonists. This may partially explain the differences between these agents on prostate cancer outcomes. In this post-hoc analysis, FSH and prostate specific antigen (PSA) responses and the impact of cross-over from leuprolide to degarelix were evaluated from a 1-year comparative study (CS21) and its extension study (CS21A).
Materials and methods: Overall, 610 patients were enrolled in CS21, wherein PSA and FSH levels were evaluated monthly. CS21A evaluated 386 patients, including those previously treated with degarelix (n = 251) who continued to receive degarelix, and those previously treated with leuprolide (n = 135) who crossed-over to receive degarelix. PSA and FSH levels were evaluated in CS21A for 3 months after cross-over. The associations between measurements were assessed using Spearman’s correlation coefficient. The impact of class variables on FSH suppression were evaluated using Analysis of Variance.
Results: Rapid PSA and FSH suppression was observed and maintained in the degarelix arm (CS21 and CS21A), while patients on leuprolide experienced rising PSA during CS21. Patients crossed-over from leuprolide to degarelix achieved a suppression of FSH and a significant PSA decrease. PSA and FSH levels were significantly (p < .05) correlated at months 1, 3, 6, 12 and 13 in the degarelix arm.
Conclusions: Significant FSH suppression with GnRH antagonists may explain its advantage over GnRH agonists in terms of better prostate cancer control. The effect of profound FSH suppression is analogous to the need for profound testosterone suppression for tumor control.
Disclosure of interest
No potential conflict of interest was reported by the authors.
Acknowledgements
Medical writing support was provided by Mohit Joshi and Tania Peshin (Tata Consultancy Services), funded by Ferring pharmaceuticals.
Additional information
Funding
Notes on contributors
E. David Crawford
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
B. Tombal
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
T. Keane
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
F. Boccardo
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
K. Miller
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
N. Shore
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
J.-E. Damber
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
L. Collette
Dr. Crawford is a distinguished Professor of Surgery, Urology, and Radiation Oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus. Dr. Tombal is the Chairman of the Division of Urology and Professor of Urology at the Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Brussels, Belgium. Dr. Keane is professor and chairman of the Department of Urology at the Medical University of South Carolina in Charleston and specializes in managing prostate, bladder, and renal cancers. Dr. Boccardo is a professor at University of Genoa and director of the Academic Unit of Medical Oncology at Policlinico San Martino, Genoa. He is specialised in the management of urologic tumors. Dr. Miller is a urology specialist in Berlin. Dr. Shore is the Director, CPI at Carolina Urologic Research Center. Dr. Moul is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. Dr. Damber is a professor of urology in Sweden. Dr. Collette is the Associate Head of the Statistics Department and Head of the Independent Data Monitoring Committee (IDMC) Department at EORTC. Dr. Persson was a consultant to Ferring Pharmaceuticals.
